What are the EDF treatment guidelines for hidradenitis suppurativa (HS)?

Answer

In the published guidelines for hidradenitis suppurativa developed by the Guidelines Subcommittee of the European Dermatology Forum,^[1]it is recommended that hidradenitis suppurativa be treated based on the subjective impact and objective severity of the disease, as follows:

Locally recurring lesions can be treated surgically
Medical treatment either as monotherapy or in combination with surgery is more appropriate for widely spread lesions
Medical therapy may include antibiotics and immunosuppressants

A Hurley severity grade‒relevant treatment of hidradenitis suppurativa is recommended by the expert group with the following treatment algorithm:

Limited surgery such as deroofing and laser ablation techniques are especially suited for recurrent hidradenitis suppurativa lesions at fixed locations in Hurley 1/mild Hurley II stage
Wide surgical excision is appropriate for moderate Hurley II/Hurley III stage
Topical clindamycin is recommended for localized Hurley I stage

Systemic treatment (clindamycin + rifampin/tetracycline or acitretin) with adjuvant therapy (pain management treatment of superinfections is proposed for Hurley II stage)

Systemic biologics (adalimumab/infliximab) are reserved for treatment-resistant, moderate-to-severe hidradenitis suppurativa (moderate Hurley II/Hurley III stage)
General measures are offered for all patients and include weight loss and tobacco abstinence ^[1]

Based on expert opinion it is recommended that adjuvant therapy is offered to all patients in the form of general measures such as weight reduction, cessation of cigarette smoking, and specific help with bandaging lesions in order to improve the patients’ quality of life. Hidradenitis suppurativa‒specific bandages are not currently available.^[1]Choice of dressing is based on clinical experience.^[54]In addition, adhesive tape should be avoided to minimize trauma to inflamed skin, which can be overcome by using tubular net bandages or superabsorbent pads or materials in the seams of clothing.^[2]

Regarding local wound care, superabsorbent dressings are best to treat actively draining lesions or postoperative wounds, but there are no trials or studies to support this recommendation.^[1]In order to prevent the primary dressing from sticking to the wound, white petrolatum, zinc oxide paste, or film-forming liquid acrylate should be extensively and generously applied on the marginal skin as the best ways to keep the wound dressings in place.^[2]

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Media Gallery

Vulvar hidradenitis suppurativa.
Vulvar and inguinal indurations.
Sinus tract.
Draining sinus tract.
Axillary hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Close-up view of axillary hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Submammary hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Double-ended-comedones. Hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Inguinal hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Close-up view of inguinal hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Pyoderma gangrenosum in a patient with hidradenitis suppurativa.
Close-up view of pyoderma gangrenosum in a patient with hidradenitis suppurativa.
Coexisting hidradenitis suppurativa and pyoderma gangrenosum.
Coexisting hidradenitis suppurativa and pyoderma gangrenosum.
Hidradenitis suppurativa in a patient with pyoderma gangrenosum.

of 15

Author

Marina Jovanovic, MD, PhD Chief of Dermatology Ward and Contact Dermatitis Investigative Unit, Clinic of Dermatoveneroleogic Diseases, Clinical Center, Novi Sad, Serbia; Professor in Dermatology, Medical Faculty, University of Novi Sad, Vojvodina, Serbia

Disclosure: Nothing to disclose.

Coauthor(s)

George Kihiczak, MD Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital

George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.

Additional Contributors

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.

Acknowledgements

Diana Fite, MD, FACEP Clinical Assistant Professor, Department of Emergency Medicine, University of Texas Medical School at Houston, Hermann Hospital

Diana Fite, MD, FACEP is a member of the following medical societies: American Association of Women Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John Geibel, MD, DSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; Ardelyx Ownership interest Board membership

Ravi Pokala Kiran, MBBS, MS, FRCS (Eng), FRCS (Glas) Staff Physician, Department of General Surgery, St Mary's Hospital

Disclosure: Nothing to disclose.

David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Naveen Pokala, MBBS, MS, FRCS Staff Physician, Department of Surgery, Bronx Lebanon Hospital

Disclosure: Nothing to disclose.

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